The mayor of Carmel, Indiana said that regular testing of frontline workers for Covid-19 is critical to flattening the curve and saving lives.

Starting next week, city workers on the frontline of the Covid-19 pandemic in Carmel, Indiana will be tested weekly for the virus.

In the first week, the city of about 100,000 people just north of Indianapolis expects to test about 350 police officers, firefighters and EMS personnel, as well as city staffers who still have to physically show up to work, like those in charge of code enforcement on construction sites and sewer utility workers.

“Having the ability to regularly test our frontline employees will be very helpful,” said Mayor Jim Brainard. “The U.S. should have been flattening the curve eight weeks ago, but we’re now doing what we can locally to prevent our resources from being overburdened. This will help us slow the rate of infection and keep people alive.”

The city anticipates spending between $500,000 and $600,000 on testing at a rate of $150 per test. They plan to eventually test all 1,800 city employees and dependents on their health plan, with emergency workers and frontline employees prioritized and submitted to weekly testing. The city is relying on an infectious disease model that shows they’ll only need to test for about 30 days, at which point Brainard is hopeful that an antibody test currently in development at a local lab will allow them to know which frontline employees have been infected and could then have some immunity to the disease. Brainard said that once the city can conduct the antibody test, the number of people who will need to be tested weekly can drop.

While the city wants to eventually roll out regular testing to all municipal employees, and potentially all city residents, Brainard said at the moment they are primarily focused on first responders. This will not only help protect those employees, but also the health of the broader community, he said. Officials fear a scenario where a first responder catches Covid-19 but doesn’t display any symptoms, potentially leading them to spread the virus to other city employees and people whose houses they enter while responding to calls. The CDC this week estimated that up to 25% of those infected with coronavirus will not experience any symptoms.

Officials in the city changed 911 response protocols a few weeks ago to limit the number of first responders who enter a home. In addition, patients are immediately given a mask to wear, regardless of whether they called with Covid-19 symptoms or not. “We’re doing as much as we possibly can to keep ourselves and our community safe,” said Tim Griffin of the Carmel Fire Department. “We’re used to dealing with emergencies, and we’re continuously adapting to new findings.”

A few weeks ago, those adaptations included sanitizing ambulances after every run and taking temperatures of EMS personnel daily. But officials recently stepped up protocols, requiring workers to enter fire stations through only one door where they use a sanitizing station and have their temperature taken—the first of three times that day. There’s also a 13-layer contingency plan for staffing shortages that would require command staff from the public education and inspections divisions to step up to fill needed jobs, Griffin said.

Six people are still sent out on every EMS call, but only two enter the home now, fully covered in personal protective equipment. Social distancing is happening in the fire stations, as well, with each worker staying in a separate bedroom—and, now, everyone will be required to report for Covid-19 testing at least once a week. “By doing testing on us, we’re keeping other people safe,” said Griffin, explaining that EMS personnel regularly interact with cancer patients and other immunocompromised people who are particularly vulnerable to coronavirus. “Because so many people could be asymptomatic, adding this layer shows the immense care and caution we’re using with our residents.”

The process for testing takes about 30 seconds and the city is contracting with Aria Diagnostics, a local lab that says it can turn tests around in two to three days, or within 24 hours for urgent cases. The city has been coordinating with lab owner Zak Khan, who also runs a surgery center that does endoscopies, nerve blocks, and other minimally invasive procedures, all of which were indefinitely postponed by Gov. Eric Holcomb’s executive order cancelling elective surgeries to preserve PPE and other resources for the Covid-19 response. Khan has converted the center’s molecular lab that usually does toxicology tests to run Covid-19 tests instead. “The testing process is sort of like a patent,” Khan explained. “Once the CDC released the lab protocols, every commercial lab can do this.”

Once labs run a validation study using the protocol, they’re free to begin testing for the virus. Khan said his staff is “getting better at it by the day” and are working to speed up results so that they can get police and firefighters “back in the field as quickly as possible.” The lab first started working with Carmel last week, and are now servicing about 15 cities and counties in Indiana, all of which want testing for their first responders. The lab built a municipal website for each city, and patients fill out their information in advance, allowing nurses to quickly check them in when they arrive at a lab parking lot for their nasal swab.

Khan hopes to be able to provide other municipalities across the country with the information they need to stand up similar operations. He said that getting a lab certified to perform Covid-19 tests is a “generic process” associated with clear guidance from the CDC. The harder part is finding supplies. The Covid-19 test requires a nasopharyngeal swab—basically an extended Q-tip that sits in a vial filled with a transport medium like saline—something in such short supply that some hospitals have resorted to manufacturing their own. Khan has been buying the component parts of the test separately and then assembling them.

Khan is now setting up a mobile clean room to assemble all the pieces of the tests and during a trial run with six workers was able to produce 10,000 in four hours. He hopes that other labs will soon follow suit and assemble kits that can be sent to hotspots like New York City, something Khan plans to do in the next few weeks. “There are so many clean rooms in this country and so many people who could do this,” he said. “You don’t have to be a scientist to aliquot the medium into vials, you just need to be trained and use PPE.”

So far, several infected police officers in Carmel have been identified and asked to quarantine. Brainard said he hopes these kind of efforts will mean the local health system isn’t overwhelmed. “We’re tamping down the curve that was predicted even five or six days ago,” he said. “We’re doing all we can to keep the community safe.”